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# Spironolactone (Aldactone)
## Overview
Spironolactone is a potassium-sparing diuretic and aldosterone antagonist.
## Primary Indications
* Heart failure (reduced ejection fraction)
* Hypertension (in combination with other agents)
* Edema (due to cirrhosis, nephrotic syndrome, or congestive heart failure)
* Primary hyperaldosteronism
* Hirsutism in women
## Adult Dosing
* **Heart Failure:** Start at 25 mg once daily. May increase to 50 mg once daily. Maximum 100 mg once daily.
* **Hypertension:** 25-100 mg once daily, often in combination with other antihypertensives.
* **Edema (Cirrhosis/Nephrotic Syndrome):** 25-100 mg once daily, may be increased based on response.
* **Primary Hyperaldosteronism:** 100-400 mg daily divided in 2-4 doses.
* **Hirsutism:** 25-200 mg once daily.
Dosing for specific indications can vary based on local protocol and patient response.
## Pediatric Dosing
* **Edema/Hypertension:** 1.5-3 mg/kg/day divided into 2-4 doses. Maximum 100 mg/day.
* **Hirsutism:** Dosing is less established, but generally 100-200 mg/day.
Specific pediatric dosing may depend on the indication and local protocols.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Avoid in severe renal impairment.
* **Hepatic Impairment:** Use with caution.
## Contraindications
* Addison's disease
* Anuria
* Hyperkalemia
* Known hypersensitivity to spironolactone or its components
* Severe renal impairment
## Adverse Effects
* Hyperkalemia (most significant)
* Gynecomastia, menstrual irregularities, breast tenderness
* Dizziness, headache, fatigue
* Gastrointestinal upset (nausea, vomiting, diarrhea)
* Hypotension
* Renal dysfunction
## Key Drug Interactions
* **ACE inhibitors, ARBs, other potassium-sparing diuretics, potassium supplements:** Increased risk of hyperkalemia.
* **NSAIDs:** May reduce diuretic efficacy and increase risk of hyperkalemia.
* **Lithium:** Spironolactone may decrease renal clearance of lithium, leading to lithium toxicity.
* **Digoxin:** Spironolactone may increase digoxin levels.
## Monitoring
* Serum potassium levels (especially at initiation, dose changes, and with concomitant medications)
* Renal function (BUN, creatinine)
* Blood pressure
* Electrolytes
## Clinical Pearls
* Administer with food to enhance absorption and reduce gastrointestinal upset.
* Hyperkalemia is the most serious adverse effect; monitor closely, especially in patients with renal impairment or those taking other medications that increase potassium.
* Due to its anti-androgenic effects, it can cause feminizing effects in men.
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*This information is intended as a quick reference and does not replace comprehensive drug information resources. Always consult the current prescribing information for the specific product being used.*
